经冠状动脉自体骨髓干细胞移植治疗急性前壁心肌梗死的临床研究

Clinical study of autologous intravenous and coronary artery bone marrow stem cells transplantation in acute anterior myocardial infarction treatment

目的 评价经冠状动脉自体骨髓干细胞（MSCs）移植治疗急性前壁心肌梗死的有效性和安全性.方法 入选我院心内科急性前壁心肌梗死住院患者20例,随机分成两组,每组10例.治疗组PCI后经冠状动脉行骨髓干细胞移植,对照组单纯PCI治疗.出院前及移植后定期复查心脏彩超、心肌核素显像（SPECT）及6 min步行试验.结果 ①心脏彩超检查：治疗组术后心功能逐渐好转,随访6个月左室射血分数（LVEF）由（50.5±6.6）%提高至（63.9±7.9）%（P＜0.05）,与对照组比较,差异有统计学意义（P＜0.05）.②SPECT：对照组无明显变化,治疗组心肌灌注显像明显改善.③6 min步行试验：随访6个月,两组较出院前均明显改善（P＜0.05）,组间比较差异无统计学意义（P＞0.05）.结论 经冠状动脉自体MSCs移植治疗急性前壁心肌梗死安全、有效,可能与MSCs再生心肌、抑制心室重构、改善心功能有关.

Objective To evaluate the efficacy and safety of autologous bone marrow stem cells （MSCs） transplantation in treatment of acute anterior myocardial infarction （MI）. Methods Twenty patients with acute anterior MI were included. After emergency percutaneous coronary intervention（PCI） for the guilty coronary artery, 10 patients were transplanted with autolougous MSCs （MSCs group）via coronary artery. The other 10 patients were taken as control. Results （1）Mter 6 months of follow-up, left ventricular ejection fraction （LVEF） increased sig- nificantly in MSCs group when compared with control group （P〈0.05）.（2）SPECT demonstrated significant improve- meut myocardial perfusion imaging after transplantation of MSCs. （3）Six-minute-walk distance elevated significantly six months after MSCs transplantation compared with pre-transplantation（P〈O.05）. But the changes between MSCs group and control group were not significant different. （P〉0.05）. Conclusion Autologous intracoronary MSCs transplantation for acute anterior MI treatment is safe and effective. The underlying mechanism may result from that stem cell transplantation into the necrotic area of myocardial cells can complement myocardial cells and prevention of leftventricular remodeling and heart failure.